The department reimburses pharmacies the lesser of the pharmacy's usual and customary charge to the general public or the applicable state or federal established maximum allowable amount, whichever is less. The payment also includes a dispensing fee.
The Illinois Medicaid program covers all prescription drugs, as well as some over-the-counter (OTC) products, made by manufacturers that have a signed rebate agreement with the federal Centers for Medicare and Medicaid Services (CMS). Some prescription drugs and OTC products require prior approval from the department before reimbursement will be allowed.
For further information about the department's drug coverage, including information about prior approval and the department's Drugs and Therapeutics (D and T) Committee, visit HFS Medicaid Pharmacy Information.